- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,884.03 / $9,332.54
| Facility | | $812.83 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,691.53 / $8,912.51
| Facility | | $2,187.76 | $2,691.53 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $13,182.57
| Facility | | $7,413.10 | $12,022.64 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $2,238.72
| Professional | | $446.68 | $741.31 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,165.95
| Facility | | $1,288.25 | $3,467.37 | $6,165.95 |